Coriddi Michelle, Wee Corrine, Meyerson Joseph, Eiferman Daniel, Skoracki Roman
Department of Plastic Surgery, The Ohio State University, Columbus, OH.
Department of General Surgery, The Ohio State University, Columbus, OH.
J Am Coll Surg. 2017 Nov;225(5):650-657. doi: 10.1016/j.jamcollsurg.2017.08.001. Epub 2017 Aug 14.
Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple donor sites have been described and each has significant disadvantages. We propose the jejunal mesentery as a novel donor site for VLNT.
We performed a cadaveric anatomic study analyzing jejunal lymph nodes (LNs) and describe outcomes from the first patients who received jejunal mesenteric VLNT for treatment of lymphedema.
In 5 cadavers, the average numbers of total LNs and peripheral LNs were identified in the proximal, middle, and distal segments of jejunum. Totals counted were 19.2/13.8/9.6, (SD 7.0/4.4/1.1), respectively; of those, 10.4/6.8/3.4 (SD 3.6/2.3/2.6), respectively, were in the periphery. There were significantly more total and peripheral lymph nodes in the proximal segment compared with the middle and distal segments (p = 0.027 and p = 0.008, respectively). The jejunal VLNT was used in 15 patients for treatment of upper (n = 8) or lower (n = 7) extremity lymphedema. Average follow-up was 9.1 (±6.4) months (range 1 to 19 months). Of 14 patients with viable flaps (93.3%), 12 had subjective improvement (87.5%). Ten patients had preoperative measurements, and of those, 7 had objective improvement in lymphedema (70%).
The jejunal mesenteric VLNT is an excellent option for lymphedema treatment because there is no risk of donor site lymphedema or nerve damage, and the scar is easily concealed. Harvest from the periphery of the proximal jejunum is optimal. Improvement from lymphedema can be expected in a majority of patients.
带血管蒂淋巴结转移术（VLNT）是一种治疗淋巴水肿的手术方法。已有多种供区被描述，但每种都有明显缺点。我们提出将空肠系膜作为VLNT的一个新供区。
我们进行了一项尸体解剖研究，分析空肠淋巴结（LN），并描述了首例接受空肠系膜VLNT治疗淋巴水肿患者的治疗结果。
在5具尸体中，确定了空肠近端、中段和远端的总淋巴结数和外周淋巴结数的平均值。总数分别为19.2/13.8/9.6（标准差7.0/4.4/1.1）；其中，外周分别为10.4/6.8/3.4（标准差3.6/2.3/2.6）。近端的总淋巴结和外周淋巴结明显多于中段和远端（分别为p = 0.027和p = 0.008）。15例患者接受了空肠系膜VLNT治疗上肢（n = 8）或下肢（n = 7）淋巴水肿。平均随访时间为9.1（±6.4）个月（范围1至19个月）。14例皮瓣存活患者（93.3%）中，12例有主观改善（87.5%）。10例患者术前有测量数据，其中7例淋巴水肿有客观改善（70%）。
空肠系膜VLNT是治疗淋巴水肿的一个极佳选择，因为不存在供区淋巴水肿或神经损伤风险，且瘢痕易于隐藏。从空肠近端外周取材最佳。大多数患者的淋巴水肿有望得到改善。
